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Article ; Online: The Effect of Combining Spinal Manipulation and Dry Needling in Individuals With Nonspecific Low Back Pain.

Farley, Jedidiah / Taylor-Swanson, Lisa / Koppenhaver, Shane / Thackeray, Anne / Magel, Jake / Fritz, Julie M

2024 , Page(s) 104506

Abstract: Low back pain (LBP) is one of the most common and costly musculoskeletal conditions impacting health care in the United States. The development of multimodal strategies of treatment is imperative in order to curb the growing incidence and prevalence of ... ...

Abstract	Low back pain (LBP) is one of the most common and costly musculoskeletal conditions impacting health care in the United States. The development of multimodal strategies of treatment is imperative in order to curb the growing incidence and prevalence of LBP. Spinal manipulative therapy (SMT), dry needling (DN), and exercise are common nonpharmacological treatments for LBP. This study is a 3-armed parallel-group design randomized clinical trial. We enrolled and randomized 96 participants with LBP into a multimodal strategy of treatment consisting of a combination of DN and SMT, DN only, and SMT only, followed by an at-home exercise program. All participants received 4 treatment sessions in the first 2 weeks followed by a 2-week home exercise program. Outcomes included clinical (Oswestry Disability Index, numeric pain intensity rating) and mechanistic (lumbar multifidus, erector spinae, and gluteus medius muscle activation) measures at baseline, 2, and 4 weeks. Participants in the DN and SMT groups showed larger effects and statistically significant improvement in pain and disability scores, and muscle percent thickness change at 2 weeks and 4 weeks of treatment when compared to the other groups. This study was registered prior to participant enrollment. PERSPECTIVE: This article presents the process of developing an optimized multimodal treatment plan utilizing SMT, DN, and exercise to address the burden of LBP for impacted individuals and the health care system. This method could potentially help clinicians who treat LBP to lower initial pain and increase exercise compliance. (clinicaltrials.gov NCT05802901).
Language	English
Publishing date	2024-03-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2018789-0
ISSN	1528-8447 ; 1526-5900
ISSN (online)	1528-8447
ISSN	1526-5900
DOI	10.1016/j.jpain.2024.03.002
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Article ; Online: Use of implementation mapping in the planning of a hybrid type 1 pragmatic clinical trial: the BeatPain Utah study.

Fritz, Julie M / Gibson, Bryan / Wetter, David W / Del Fiol, Guilherme / Solis, Victor / Ford, Isaac / Lundberg, Kelly / Thackeray, Anne

Implementation science communications

2024 Volume 5, Issue 1, Page(s) 3

Abstract: Background: Considerable disparities in chronic pain management have been identified. Persons in rural, lower income, and minoritized communities are less likely to receive evidence-based, nonpharmacologic care. Telehealth delivery of nonpharmacologic, ... ...

Abstract	Background: Considerable disparities in chronic pain management have been identified. Persons in rural, lower income, and minoritized communities are less likely to receive evidence-based, nonpharmacologic care. Telehealth delivery of nonpharmacologic, evidence-based interventions for persons with chronic pain is a promising strategy to lessen disparities, but implementation comes with many challenges. The BeatPain Utah study is a hybrid type 1 effectiveness-implementation pragmatic clinical trial investigating telehealth strategies to provide nonpharmacologic care from physical therapists to persons with chronic back pain receiving care in ommunity health centers (CHCs). CHCs provide primary care to all persons regardless of ability to pay. This paper outlines the use of implementation mapping to develop a multifaceted implementation plan for the BeatPain study. Methods: During a planning year for the BeatPain trial, we developed a comprehensive logic model including the five-step implementation mapping process informed by additional frameworks and theories. The five iterative implementation mapping steps were addressed in the planning year: (1) conduct needs assessments for involved groups; (2) identify implementation outcomes, performance objectives, and determinants; (3) select implementation strategies; (4) produce implementation protocols and materials; and (5) evaluate implementation outcomes. Results: CHC leadership/providers, patients, and physical therapists were identified as involved groups. Barriers and assets were identified across groups which informed identification of performance objectives necessary to implement two key processes: (1) electronic referral of patients with back pain in CHC clinics to the BeatPain team and (2) connecting patients with physical therapists providing telehealth. Determinants of the performance objectives for each group informed our choice of implementation strategies which focused on training, education, clinician support, and tailoring physical therapy interventions for telehealth delivery and cultural competency. We selected implementation outcomes for the BeatPain trial to evaluate the success of our implementation strategies. Conclusions: Implementation mapping provided a comprehensive and systematic approach to develop an implementation plan during the planning phase for our ongoing hybrid effectiveness-implementation trial. We will be able to evaluate the implementation strategies used in the BeatPain Utah study to inform future efforts to implement telehealth delivery of evidence-based pain care in CHCs and other settings. Trial registration: ClinicalTrials.gov Identifier: NCT04923334 . Registered June 11, 2021.
Language	English
Publishing date	2024-01-05
Publishing country	England
Document type	Journal Article
ISSN	2662-2211
ISSN (online)	2662-2211
DOI	10.1186/s43058-023-00542-z
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Article ; Online: Effect of Patient Use of Physical Therapy After Referral for Musculoskeletal Conditions on Future Medical Utilization: A Retrospective Cohort Analysis.

Sharpe, Jason A / Martin, Brook I / Magel, John / Fritz, Julie M / Vanneman, Megan E / Thackeray, Anne

Journal of manipulative and physiological therapeutics

2022 Volume 44, Issue 8, Page(s) 621–636

Abstract: Objective: The purpose of this study was to evaluate whether physical therapy use influenced subsequent use of musculoskeletal-related surgeries, injections, magnetic resonance imaging (MRI), and other imaging.: Methods: We conducted a retrospective ... ...

Abstract	Objective: The purpose of this study was to evaluate whether physical therapy use influenced subsequent use of musculoskeletal-related surgeries, injections, magnetic resonance imaging (MRI), and other imaging. Methods: We conducted a retrospective cohort study of patients aged 18 to 64 years who had an ambulatory care visit at the University of Utah system, after implementation of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems with adequate data collection in the system at the time of the data pull, between October 1, 2015, and September 30, 2018. We identified patients (n = 85 186) who received care for a musculoskeletal condition (lower back pain, cervical, knee, shoulder, hip, elbow, ankle, wrist/hand, thoracic, and arthritis diagnoses). Regression analyses were used to evaluate the association between physical therapy use and medical care use while controlling for relevant factors. Results: In patients referred to physical therapy (n = 15 870), physical therapy use (n = 3812) was associated with increased MRI use (incidence rate ratio, 1.24; 95% confidence interval, 1.15-1.33; P < .001) and surgery use (incidence rate ratio, 1.11; 95% confidence interval, 1.00-1.23; P < .001). Several other factors were also associated with increased health care use, including being referred by an orthopedic provider, obesity, non-lower back pain diagnoses, and having 1 or more comorbidities. Conclusion: Outpatient physical therapy use for musculoskeletal conditions in adult patients younger than 65 years at the University of Utah system, a mountain west United States academic health care system, was associated with increased rates of MRI and surgery. This finding is contrary to prior research suggesting that physical therapy improves outcomes in some diagnosis groups. A referral from an orthopedic provider, non-lower back pain diagnoses, and obesity were also associated with increased medical care utilization.
MeSH term(s)	Adult ; Humans ; Low Back Pain ; Musculoskeletal Diseases/diagnosis ; Musculoskeletal Diseases/therapy ; Obesity ; Physical Therapy Modalities ; Referral and Consultation ; Retrospective Studies ; United States
Language	English
Publishing date	2022-03-16
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	761054-3
ISSN	1532-6586 ; 0161-4754
ISSN (online)	1532-6586
ISSN	0161-4754
DOI	10.1016/j.jmpt.2022.01.001
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Article: Use of implementation mapping in the planning of a hybrid type 1 pragmatic clinical trial: the BeatPain Utah study.

Fritz, Julie M / Gibson, Bryan / Wetter, David W / Fiol, Guilherme Del / Solis, Victor H / Ford, Isaac / Lundberg, Kelly / Thackeray, Anne

Research square

2023

Abstract: Background: Considerable disparities in chronic pain management have been identified. Persons in rural, lower income and minoritized communities are less likely to receive evidence-based, nonpharmacologic care. Telehealth delivery of nonpharmacologic, ... ...

Abstract	Background: Considerable disparities in chronic pain management have been identified. Persons in rural, lower income and minoritized communities are less likely to receive evidence-based, nonpharmacologic care. Telehealth delivery of nonpharmacologic, evidence-based interventions for persons with chronic pain is a promising strategy to lessen disparities, but implementation comes with many challenges. The BeatPain Utah study is a hybrid type I effectiveness-implementation pragmatic clinical trial investigating telehealth strategies to provide nonpharmacologic care from physical therapists to persons with chronic back pain receiving care in Community Health Centers (CHCs). CHCs provide primary care to all persons regardless of ability to pay. This paper outlines the use of implementation mapping to develop a multifaceted implementation plan for the BeatPain study. Methods: During a planning year for the BeatPain trial we developed a comprehensive logic model including the 5-step implementation mapping process informed by additional frameworks and theories. The five iterative implementation mapping steps were addressed in the planning year; 1) conduct needs assessments for involved groups; 2) identify implementation outcomes, performance objectives and determinants; 3) select implementation strategies; 4) produce implementation protocols and materials; and 5) evaluate implementation outcomes. Results: CHC leadership/providers, patients and physical therapists were identified as involved groups. Barriers and assets were identified across groups which informed identification of performance objectives necessary to implement two key processes; 1) electronic referral of patients with back pain in CHC clinics to the BeatPain team; and 2) connecting patients with physical therapists providing telehealth. Determinants of the performance objectives for each group informed our choice of implementation strategies which focused on training, education, clinician support and tailoring physical therapy interventions for telehealth delivery and cultural competency. We selected implementation outcomes for the BeatPain trial to evaluate the success of our implementation strategies. Conclusions: Implementation mapping provided a comprehensive and systematic approach to develop an implementation plan during the planning phase for our ongoing hybrid effectiveness-implementation trial. We will be able to evaluate the implementation strategies used in the BeatPain Utah study to inform future efforts to implement telehealth delivery of evidence-based pain care in CHCs and other settings. Trial registration: Clinicaltrials.gov Identifier: NCT04923334. Registered June 11, 2021 (https://clinicaltrials.gov/study/NCT04923334.
Language	English
Publishing date	2023-09-11
Publishing country	United States
Document type	Preprint
DOI	10.21203/rs.3.rs-3267087/v1
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Article ; Online: Linking AM-PAC Mobility and Daily Activity to the PROMIS Physical Function Metric.

Thackeray, Anne / Hanmer, Janel / Yu, Lan / McCracken, Polly / Marcus, Robin

Physical therapy

2021 Volume 101, Issue 8

Abstract: Objective: The purpose of this study was to link Activity Measure for Post-Acute Care (AM-PAC) Mobility and Daily Activity scales to the PROMIS Physical Function (PF) allowing for a common metric across scales.: Methods: Cross-sectional study of ... ...

Abstract	Objective: The purpose of this study was to link Activity Measure for Post-Acute Care (AM-PAC) Mobility and Daily Activity scales to the PROMIS Physical Function (PF) allowing for a common metric across scales. Methods: Cross-sectional study of patients 18 years and older presenting to 1 of 8 outpatient rehabilitation clinics in southwestern Pennsylvania. Patients completed one survey with questions from the AM-PAC Daily Activity and Mobility short forms, and the PROMIS PF item bank. Using item response theory, 2 rounds of fixed-parameter calibration were performed. In the first, the AM-PAC Daily Activity and Mobility items were calibrated with 27 fixed item parameters from the PROMIS PF. Second, the AM-PAC Daily Activity items were calibrated with 11 PROMIS Upper Extremity fixed item parameters. This process uses the construct of physical function and equates AM-PAC items on the same underlying measurement scale for the PROMIS PF. Results: Both scales measured a wide range of functioning and demonstrated good calibration. Data were appropriate for a fixed-parameter item response theory-based crosswalk. AM-PAC Daily Activity and Mobility raw scores were mapped onto the PROMIS PF metric. AM-PAC Daily Activity scores were also mapped onto the PROMIS PF Upper Extremity metric. Conclusion: Question items from the AM-PAC Daily Activity, AM-PAC Mobility, and PROMIS PF similarly measure the construct of physical function. This consistency allows for a crosswalk of AM-PAC scores onto the PROMIS PF metric. Impact: Crosswalk tables developed in this study allow for converting scores from the AM-PAC Daily Activity and Mobility scales to the PROMIS PF metric. This will facilitate monitoring of longitudinal change in function over time and across settings.
MeSH term(s)	Activities of Daily Living ; Aged ; Cross-Sectional Studies ; Female ; Humans ; Male ; Middle Aged ; Patient Reported Outcome Measures ; Psychometrics ; Rehabilitation/standards ; Surveys and Questionnaires/standards
Language	English
Publishing date	2021-03-11
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Multicenter Study ; Research Support, N.I.H., Extramural
ZDB-ID	415886-6
ISSN	1538-6724 ; 0031-9023
ISSN (online)	1538-6724
ISSN	0031-9023
DOI	10.1093/ptj/pzab084
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Article ; Online: Linking AM-PAC Cognition to PROMIS Cognitive Function.

Thackeray, Anne / Marcus, Robin L / Yu, Lan / McCracken, Polly / Cardell, Beth / Hanmer, Janel

Archives of physical medicine and rehabilitation

2021 Volume 102, Issue 11, Page(s) 2157–2164.e1

Abstract: Objective: To link the Activity Measure for Post-Acute Care (AM-PAC) Applied Cognition to the Patient-Reported Outcomes Measurement Information System (PROMIS) Cognitive Function, allowing for a common metric across scales.: Design: Cross-sectional ... ...

Abstract	Objective: To link the Activity Measure for Post-Acute Care (AM-PAC) Applied Cognition to the Patient-Reported Outcomes Measurement Information System (PROMIS) Cognitive Function, allowing for a common metric across scales. Design: Cross-sectional survey study. Setting: Outpatient rehabilitation clinics. Participants: Consecutive sample of 500 participants (N=500) aged ≥18 years presenting for outpatient therapy (physical, occupation, speech). Interventions: Not applicable. Main outcome measures: AM-PAC Medicare and Generic Cognition short forms and PROMIS Cognitive Function items representing the PROMIS Cognitive Function item bank. Results: The calibration of 25 AM-PAC cognition items with 11 fixed PROMIS cognitive function item parameters using item-response theory indicated that items were measuring the same underlying construct (cognition). Both scales measured a wide range of functioning. The AM-PAC Generic Cognitive assessment showed more reliability with lower levels of cognition, whereas the PROMIS Cognitive Function full-item bank was more reliable across a larger distribution of scores. Data were appropriate for a fixed-anchor item response theory-based crosswalk and AM-PAC Cognition raw scores were mapped onto the PROMIS metric. Conclusions: The crosswalk developed in this study allows for converting scores from the AM-PAC Applied Cognition to the PROMIS Cognitive Function scale.
MeSH term(s)	Adult ; Aged ; Cognition Disorders/diagnosis ; Cross-Sectional Studies ; Female ; Humans ; Male ; Mental Status and Dementia Tests/standards ; Middle Aged ; Patient Reported Outcome Measures ; Quality of Life ; Racial Groups ; Rehabilitation Centers/organization & administration ; Reproducibility of Results ; Subacute Care/organization & administration ; Subacute Care/standards
Language	English
Publishing date	2021-05-26
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	80057-0
ISSN	1532-821X ; 0003-9993
ISSN (online)	1532-821X
ISSN	0003-9993
DOI	10.1016/j.apmr.2021.04.012
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Article ; Online: Patients' use of physical therapy for lower back pain: A qualitative study.

Sharpe, Jason A / Thackeray, Anne / Fritz, Julie M / Martin, Brook I / Magel, John / Vanneman, Megan E

Musculoskeletal science & practice

2021 Volume 56, Page(s) 102468

Abstract: Objective: The purpose of this study was to identify factors that influence a patient's decision to use physical therapy (PT) services for a low back pain (LBP) complaint.: Methods: Semi-structured qualitative phone interviews were conducted with ... ...

Abstract	Objective: The purpose of this study was to identify factors that influence a patient's decision to use physical therapy (PT) services for a low back pain (LBP) complaint. Methods: Semi-structured qualitative phone interviews were conducted with patients who were offered an early outpatient PT visit secondary to patients' primary appointment for LBP with a non-operative sports medicine specialist physician. Interviews were recorded, transcribed, and analyzed to identify themes using an iterative process. Results: Forty participants were interviewed; 20 accepted early PT services, and 20 did not. Patients' decisions were influenced by perceived provider training, costs, doctor recommendations, wait times, symptoms, and a desire for a diagnosis. Patients preferred the care of non-operative sports medicine doctors over physical therapists for LBP due to their beliefs that favored doctors' diagnosis and management of LBP. Patients perceived exercise as an effective treatment for back pain. Physical therapists were viewed as an adjunct service, despite positive comments about PT and the belief that exercise is one of the most effective treatments for LBP. Conclusion: Barriers including costs, patient preferences, and knowledge about physical therapists limited patients' use of PT. Value-based care strategies aimed at improving the management of LBP increasingly promote the early use of PT. For these strategies to be effective, it is critical that patient perceptions and the influence of barriers on PT use are further understood. This study highlights the need to promote confidence in physical therapists' expertise in the management and diagnosis of lower back pain.
MeSH term(s)	Back Pain ; Humans ; Low Back Pain/therapy ; Physical Therapists ; Physical Therapy Modalities ; Qualitative Research
Language	English
Publishing date	2021-10-18
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2888772-4
ISSN	2468-7812
ISSN (online)	2468-7812
DOI	10.1016/j.msksp.2021.102468
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Article ; Online: Rehabilitation to Improve Gaze and Postural Stability in People With Multiple Sclerosis: A Randomized Clinical Trial.

Loyd, Brian J / Fangman, Annie / Peterson, Daniel S / Gappmaier, Eduard / Thackeray, Anne / Schubert, Michael C / Dibble, Leland E

Neurorehabilitation and neural repair

2022 Volume 36, Issue 10-11, Page(s) 678–688

Abstract: Background: People with multiple sclerosis (PwMS) frequently experience dizziness and imbalance that may be caused by central vestibular system dysfunction. Vestibular rehabilitation may offer an approach for improving dysfunction in these people.: ... ...

Abstract	Background: People with multiple sclerosis (PwMS) frequently experience dizziness and imbalance that may be caused by central vestibular system dysfunction. Vestibular rehabilitation may offer an approach for improving dysfunction in these people. Objective: To test the efficacy of a gaze and postural stability (GPS) retraining intervention compared to a strength and endurance (SAE) intervention in PwMS. Methods: About 41 PwMS, with complaints of dizziness or history of falls, were randomized to either the GPS or SAE groups. Following randomization participants completed 6-weeks of 3×/week progressive training, delivered one-on-one by a provider. Following intervention, testing was performed at the primary (6-weeks) and secondary time point (10-weeks). A restricted maximum likelihood estimation mixed effects model was used to examine changes in the primary outcome of the Dizziness Handicap Inventory (DHI) between the 2 groups at the primary and secondary time point. Similar models were used to explore secondary outcomes between groups at both timepoints. Results: Thirty-five people completed the study (17 GPS; 18 SAE). The change in the DHI at the primary time point was not statistically different between the GPS and SAE groups (mean difference = 2.33 [95% CI -9.18, 12.85]). However, both groups demonstrated significant improvement from baseline to 6-weeks (GPS -8.73; SAE -7.31). Similar results were observed for secondary outcomes and at the secondary timepoint. Conclusions: In this sample of PwMS with complaints of dizziness or imbalance, 6-weeks of GPS training did not result in significantly greater improvements in dizziness handicap or balance compared to 6-weeks of SAE training.
MeSH term(s)	Humans ; Dizziness/etiology ; Dizziness/rehabilitation ; Multiple Sclerosis ; Postural Balance ; Vestibular Diseases
Language	English
Publishing date	2022-09-13
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1491637-x
ISSN	1552-6844 ; 1545-9683 ; 0888-4390
ISSN (online)	1552-6844
ISSN	1545-9683 ; 0888-4390
DOI	10.1177/15459683221124126
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Article ; Online: Examining the Relationship Between Individual Patient Factors and Substantial Clinical Benefit From Telerehabilitation Among Patients With Chronic Low Back Pain.

McLaughlin, Kevin H / Fritz, Julie M / Minick, Kate I / Brennan, Gerard P / McGee, Terrence / Lane, Elizabeth / Thackeray, Anne / Bardsley, Tyler / Wegener, Stephen T / Hunter, Stephen J / Skolasky, Richard L

Physical therapy

2023 Volume 104, Issue 3

Abstract: Objective: The coronavirus disease-2019 pandemic has facilitated the emergence of telerehabilitation, but it is unclear which patients are most likely to respond to physical therapy provided this way. The purpose of this study was to examine the ... ...

Abstract	Objective: The coronavirus disease-2019 pandemic has facilitated the emergence of telerehabilitation, but it is unclear which patients are most likely to respond to physical therapy provided this way. The purpose of this study was to examine the relationship between individual patient factors and substantial clinical benefit from telerehabilitation among a cohort of patients with chronic low back pain (LBP). Methods: This is a secondary analysis of data collected during a prospective longitudinal cohort study. Patients with chronic LBP (N = 98) were provided with a standardized physical therapy protocol adapted for telerehabilitation. We examined the relationship between patient factors and substantial clinical benefit with telerehabilitation, defined as a ≥50% improvement in disability at 10 weeks, measured using the Oswestry Disability Index. Results: Sixteen (16.3%) patients reported a substantial clinical benefit from telerehabilitation. Patients reporting substantial clinical benefit from telerehabilitation had lower initial pain intensity, lower psychosocial risk per the STarT Back Screening Tool, higher levels of pain self-efficacy, and reported higher therapeutic alliance with their physical therapist compared to other patients. Conclusion: Patients with lower psychosocial risk and higher pain-self efficacy experienced substantial clinical benefit from telerehabilitation for chronic LBP more often than other patients in our cohort. Therapeutic alliance was higher among patients who experienced a substantial clinical benefit compared to those who did not. Impact: This study indicates that psychosocial factors play an important role in the outcomes of patients receiving telerehabilitation for chronic LBP. Baseline psychosocial screening may serve as a method for identifying patients likely to benefit from this approach.
MeSH term(s)	Humans ; Low Back Pain/therapy ; Telerehabilitation ; Prospective Studies ; Longitudinal Studies ; Physical Therapy Modalities ; Chronic Pain
Language	English
Publishing date	2023-12-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	415886-6
ISSN	1538-6724 ; 0031-9023
ISSN (online)	1538-6724
ISSN	0031-9023
DOI	10.1093/ptj/pzad180
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Article ; Online: Effectiveness of training physical therapists in pain neuroscience education for patients with chronic spine pain: a cluster-randomized trial.

Lane, Elizabeth / Magel, John S / Thackeray, Anne / Greene, Tom / Fino, Nora F / Puentedura, Emilio J / Louw, Adriaan / Maddox, Daniel / Fritz, Julie M

Pain

2021 Volume 163, Issue 5, Page(s) 852–860

Abstract: Abstract: Chronic spinal pain poses complex challenges for health care around the world and is in need of effective interventions. Pain neuroscience education (PNE) is a promising intervention hypothesized to improve pain and disability by changing ... ...

Abstract	Abstract: Chronic spinal pain poses complex challenges for health care around the world and is in need of effective interventions. Pain neuroscience education (PNE) is a promising intervention hypothesized to improve pain and disability by changing individuals' beliefs, perceptions, and expectations about pain. Pain neuroscience education has shown promise in small, controlled trials when implemented in tightly controlled situations. Exploration of promising interventions through more pragmatic methodologies is a crucial but understudied step towards improving outcomes in routine clinical care. The purpose was to examine the impact of pragmatic PNE training on clinical outcomes in patients with chronic spine pain. The cluster-randomized clinical trial took place in 45 outpatient physical therapist (PT) clinics. Participants included 108 physical therapists (45 clinics and 16 clusters) and 319 patients. Clusters of PT clinics were randomly assigned to either receive training in PNE or no intervention and continue with usual care (UC). We found no significant differences between groups for our primary outcome at 12 weeks, Patient-Reported Outcomes Measurement Information System Physical Function computer adaptive test {mean difference = 1.05 (95% confidence interval [CI]: -0.73 to 2.83), P = 0.25}. The PNE group demonstrated significant greater improvements in pain self-efficacy at 12 and 2 weeks compared with no intervention (mean difference = 3.65 [95% CI: 0.00-7.29], P = 0.049 and = 3.08 [95% CI: 0.07 to -6.09], P = 0.045, respectively). However, a similar percentage of participants in both control (41.1%) and treatment (44.4%) groups reported having received the treatment per fidelity question (yes or no to pain discussed as a perceived threat) at 2 weeks. Pragmatic PT PNE training and delivery failed to produce significant functional changes in patients with chronic spinal pain but did produce significant improvement in pain self-efficacy over UC PT.
MeSH term(s)	Chronic Pain/therapy ; Educational Status ; Humans ; Neurosciences/education ; Physical Therapists ; Self Efficacy
Language	English
Publishing date	2021-08-06
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	193153-2
ISSN	1872-6623 ; 0304-3959
ISSN (online)	1872-6623
ISSN	0304-3959
DOI	10.1097/j.pain.0000000000002436
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